Download The front of the thigh

The front of the thigh
Femoral triangle(Scarpa’s triangle)
Is a triangular depressed area located in the
upper part of the medial aspect of the thigh
immediately below the inguinal ligament.
Boundaries
Superiorly:The inguinal ligament
(the base of the triangle)
Laterally:The medial border of sartorius
muscle
Medially:The medial border of adductor
longus muscle
The apex: directed downwards and is
formed by the meeting point of
Sartorius and adductor longus muscles
Floor: gutter shaped
from lateral to medial is made by
The iliopsoas muscle
The pectineus muscle
The adductor longus
Roof :
Formed by
1- skin
2- superficial fascia which
contains:
A-superficial inguinal lymph nodes
B-femoral branch of the genitofemoral
nerve
C- branches of ilioinguinal nerve
D-superficial branches of the femoral
artery and corresponding veins
E- terminal part of the great saphenous
vien
3- deep fascia containing the
Saphenous opining
Contents of the femoral triangle
1-Terminal part of the femoral nerve and its branches.
2- The femoral sheath
3- The femoral artery and its branches.
4- The femoral vein and its tributaries.
5- Deep inguinal lymph nodes
6- femoral branch of genitofemoral nerve
7- lateral cutaneous nerve of the thigh
T h e f e mo r a l s h e a t h
Is a funnel-shaped sleeve of fascia
surrounded the femoral artery and vein and
the associated lymphatic vessels in the
femoral triangle for 2.5 cm below the
inguinal ligament.
The femoral sheath is formed by a downwards
extension of the abdominal fascia.
Anterior wall: fascia transversalis
Posterior wall: fascia iliaca
Two Anterio-posterior septa divide the sheath into 3 compartments:
Lateral compartment (arterial) occupied by the femoral artery and femoral branch
of the genitofemoral nerve
Intermediate compartment (venous) occupied by the femoral vein Medial compartment
(lymphatic) occupied by the lymph vessels (also Called femoral
canal
 Is the small medial compartment for
the lymph vessels. 1.3 cm In length.
Femoral canal
Its upper opening is called the femoral
ring.
The femoral septum (is a
condensation of extraperitoneal
tissue), closes the ring.
The femoral ring has the following
important relations:
Anteriorly : the inguinal ligament
Posteriorly: the superior ramus of
the pubis attached to it pectineus
and its covering fascia
Medially : the lacunar ligament
Laterally : Septa separating it from
the femoral vein
The femoral canal contains:
1- fatty connective tissue
2-all the efferent lymph vessels from
the deep inguinal lymph nodes and one
of the deep inguinal lymph nodes.
Note: the femoral ring is wider in
femals because of their wider pelvis and
therefore, femoral hernia is commoner
in femals than in males
 The part of the femoral sheath that
forms the femoral canal is not adherent to
the walls of the small lymph vessels; it is
this site that forms
a potentially weak area in the abdomen.
A protrusion of peritoneum could be
forced down the femoral canal, pushing
the femoral septum. Such a condition is
known as a femoral hernia.
The lower end of the canal is normally
closed by the adherence of its medial
wall to the tunica adventitia of the
femoral vein.
A protrusion of abdominal parietal peritoneum down
through the
femoral canal to form hernial sac
In femoral hernia
The neck of the hernial sac is located
below and lateral
to the pubic tubercle
While in the inguinal hernia
The neck of the hernial sac is located
above and medial
to the pubic tubercle
Femoral hernia
Adductor canal
Adductor (Subsartorial) Canal
is an intermuscular cleft situated on
the medial aspect of the middle third of
the thigh beneath the sartorius muscle
It commences above at the apex of the
femoral triangle and ends below at the
opening in the adductor magnus.
In cross section it is triangular, having
.
1-Anteromedial wall
2-Posterior wall
3-Lateral wall
Transverse section through the middle of the
right thigh as seen from above
anterior
The Anteriomedially wall is formed by:
The sartorius muscle and fascia.
The posterior wall is formed by:
The adductor longus and magnus
The lateral wall is formed by:
The vastus medialis
The adductor canal contains :
1-The terminal part of the femoral
artery
2-The femoral vein
3-The deep lymph vessels
4-The saphenous nerve
5-The nerve to the vastus medialis
6-The terminal part of the
obturator nerve
Subsartorial plexus of nerves:
Located on the fascia under the sartorius muscle
Formed by branches from
1-Medial cutaneous nerve of the thigh
2-Saphenous nerve
3-The anterior division of obturator nerve
The femoral artery
1- It enters the thigh from
behind the inguinal ligament
as a continuation of the
external iliac artery.
2-It lies midway
between the
anterior
superior iliac
spine and the
symphysis pubis
(midinguinal
point)
3-As the femoral artery
descends downwards, its
upper half lies superficial
in the femoral triangle
while in the lower half it
lies deep in the
subsartorial (adductor)
canal
4- The femoral artery then
descends almost vertically
toward the adductor
tubercle of the femur and
ends at the opening
(Adductor hiatus) in the
adductor magnus muscle by
entering the popliteal space
as THE POPLITEAL
ARTERY
5-Relations
In the upper part of its course, femoral artery lies in the femoral
triangle (superficial)
1- Exposed to injuries 2- Good approach for taking femoral pulse
Anteriorly : (in the femoral triangle)
The femoral artery is covered by skin and fascia
Its upper part (1.5 inch) is covered by the anterior wall
Of the femoral sheath and crossed by
the femoral branch of genito-femoral
nerve
Its lower part is crossed
by the saphenous Nerve
Medially:
the femoral
vein lies medial to the
artery in the upper part
of the femoral triangle,
then
it
lies
posteromedial
and
finally posterior to the
artery at the apex of the
femoral triangle
Laterally:
The femoral nerve and
Its branches.
Posteriorly:
1-Psoas major muscle, which separates it from
the hip joint
2-The pectineus muscle with profunda femoris
vessels in between
3-The adductor longus muscle with femoral
vein in between
Because the femoral artery lies in the femoral triangle (superficial)
The following procedure can be done
Femoral Artery Catheterization
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1-Fine catheter can be inserted into the femoral artery as it descends through the femoral triangle.
2-The catheter is guided under fluoroscopic view along the external and common iliac arteries
into the aorta.
3-The catheter can then be passed into the inferior mesenteric, superior mesenteric, celiac, or
renal arteries.
4-Contrast medium can then be injected into the artery under examination and a permanent
record obtained by taking a radiograph.
Femoral Vein Catheterization
1-Femoral vein catheterization is used when rapid access to a large vein is needed.
2-The femoral vein has a constant relationship to the medial side of the femoral artery just below
the inguinal ligament and is easily cannulated.
3- Because of the high incidence of thrombosis with the possibility of fatal pulmonary embolism,
the catheter should be removed once the patient is stabilized.
Anatomy of the Procedure
1-The skin of the thigh below the inguinal ligament is supplied by the genitofemoral nerve; this
nerve is blocked with a local anesthetic.
2-The femoral pulse is palpated midway between the anterior superior iliac spine and the
symphysis pubis, and the femoral vein lies immediately medial to it.
3-At a site about two fingerbreadths below the inguinal ligament, the needle is inserted into the
femoral vein.
6- Branches of the femoral artery
 In the femoral triangle
THREE superficial branches and
TWO deep branch
I-Superficial branches
1-The superficial circumflex iliac
artery
2-The superficial epigastric
artery
3-The superficial external
pudendal
They supply cutaneous regions of the upper
thigh, lower abdomen, and perineum.
II- DEEP BRANCHES
1-The deep external pudendal artery
2-The profunda femoris artery (Deep artery of thigh)
arises from the lateral side of the femoral artery about
(4 cm) below the inguinal ligament
it gives off:
A)lateral femoral circumflex artery
B) The medial femoral circumflex artery
C) Perforating arteries .
A) lateral femoral circumflex artery:
Normally originates proximally from the
lateral side of the profunda femoris artery ,
but may arise directly from the femoral
artery
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It divides into three terminal branches:
1-ascending branch, supplies the neck
and head of the femur;
2-descending branch: connects with a
branch of the popliteal artery near the knee
Profunda
femoris artery
3-transverse branch: anastomoses with
branches from the medial femoral
circumflex artery, the inferior gluteal artery,
and the first perforating artery to form the
cruciate anastomosis around the hip.
B) The medial circumflex femoral artery
normally originates proximally from the
posteromedial aspect of the profunda femoris artery
but may originate from the femoral artery
It gives off : Read only
a) Acetabular branch: which enters the hip
joint through the acetabular notch and
anastomoses with the acetabular branch of the
obturator artery.
b) Ascending branch: shears in the trochonteric anastomosis
c) Transverse branch: shears in the cruciate anastomosis
C) Perforating arteries .
The profunda femoris artery gives off perforating branches.
The first three arteries arise as branches
of the profunda femoris artery, while the fourth one is
the termination of the profunda femoris artery
profunda
femoris
artery
In the lower part of its course,
the femoral artery passes behind the
sartorius ( deep) muscle in the
subsartorial canal (adductor canal).
Relations of the femoral artery
In the subsartorial canal
Anteriomedially:
Skin and fascia
Sartorius muscle and fibrous roof
of the canal
Saphenous nerve which crosses from
lateral to medial
Anterolaterally:
vastus medialis
Nerve to vastus medialis
Posteriorly:
femoral vein
Branches of the femoral artery in the adductor canal
It gives off only one branch
The descending genicular artery
Other arteries that shear in the blood
Supply of the lower limb
Obturator Artery
The obturator artery is a branch of the
internal iliac artery
 It passes forward on the lateral wall of
the pelvis and accompanies the
obturator nerve
It gives off muscular branches and an
articular branch to the hip joint